Caring for Seniors at Home: What Works, What Doesn’t

There are a sea of new housing models designed to better deliver care to seniors at home.

Though the success of the models can be unclear, recent studies are beginning to shed light on what models do—and do not—work.

In a recently published Forbes article, contributor Howard Gleckman details study findings related to Support and Services at Home (SASH), a program that is part of Vermont’s statewide health care reform initiative.

SASH, Gleckman explains, is intended to bring some basic services and care coordination to seniors living near or in low-income senior housing. The state of Vermont has also agreed to make advanced primary care available to program participants.

All SASH participants are all enrolled in Medicare, which pays the initiative a per-member per-month fee to run the program. Approximately 2,000 seniors take part—roughly 1,500 residents and 500 neighbors.

A study conducted last year by LeadingAge and RTI International found that in its first year, SASH reduced total Medicare spending by between approximately $1,700 and $2,200 per participant, compared with similar seniors who did not take part in the program. The study also revealed, though, that SASH participants used more hospital services than those who were not in the program.

Then, this November, Leading Age and the Lewin Group completed a different study of SASH and several similar “housing with services” programs that offer on-site service coordinators to help residents organize and plan care.

That study demonstrated lower hospitalization rates but increased visits to the emergency department that did not lead to a hospitalization.

Both studies, according to Gleckman, imply that better services available through senior housing may decrease medical costs.

Still, Gleckman concludes, progress has been slow. The pace can be attributed in part to combination of distrust, bureaucratic hesitation, financial disincentives, and a lack of clear evidence of that new models save money and improve care, he says.